An Integrative Strategy to Reducing Falls: The Implications of Clinical Microsystems to Decrease Fragmentation

Purpose:
Fall reduction in acute-care continues to be a challenge (Boushon, et.al, 2008). Goal: Utilize existing quality initiatives through an integrative strategy to manage extrinsic factors involving the workflow of the unit, environment, staffing, communication, and technology to decrease falls by 10%.

Significance:
The Centers for Medicare and Medicaid Services has declared hospital acquired injuries sustained from a fall a “never event” which will not be reimbursed. One third of all hospital admissions are adults over 65 years, at increased risk for falls and injury (Inouye, Brown, & Tinetti, 2009).

Strategy and Implementation:
In April 2012, a system-wide 6-Sigma falls prevention project was launched. For comparison purposes, the NDNQI definitions of falls & reporting guidelines were used to ensure consistency among seven hospitals. Evidence-based practice (EBP) strategies have been implemented and refined during the past year. Each unit is a unique microsystem, which needed to be considered during the house-wide project implementation. Targets were set using the previous year's reported data and calculated fall rates as per NDNQI. The engagement of leadership, quality unit leaders, and nurses has helped to reduce the number of falls. Multi-level Interprofessional collaboration across microsystems, and EBP projects including handoffs, safe patient handling, mobility, huddles, and hourly rounding were also integrated into the fall prevention initiative. An acuity-adjusted mean score for 8 reporting hospital units was less than the NDNQI national comparative total falls mean for last 3 quarters of 2012.

Evaluation:
Safety huddles occurring at the beginning of shifts, falls debriefings, and daily house-wide reporting of helps to bring a higher level of awareness for fall prevention strategies. Through the integration of four evidence-based practice quality improvement initiatives falls were reduced by 13%.

Implications for Practice:
Using an integrative approach for preventing patient falls across clinical microsystems helps frontline nurses to change the culture from falls are inevitable to falls can be prevented. Further, educational gaps need to be eliminated to decrease fragmentation in applying fall prevention guidelines.